Elsevier

Resuscitation

Volume 48, Issue 1, January 2001, Pages 71-75
Resuscitation

Airway management for penetrating neck injuries: the Miami experience

https://doi.org/10.1016/S0300-9572(00)00319-1Get rights and content

Introduction

A true epidemic of firearm-related interpersonal violence developed in the United States from the late 1980s through the 1990s. In 1993, this country had more licensed firearm dealers than gas stations. The homicide rate increased significantly from 1985 to 1993, which was specific to firearms and largely confined to individuals aged 15–34 years. As the non-firearm homicide rate decreased, the firearm homicide rate roughly doubled from 1987 to 1993 [1]. For trauma centers, it was predicted that firearm injuries would replace motor vehicle accidents as the leading cause of trauma death in the United States by the year 2004 [2]. Fortunately for American society, this prediction has not become reality. In fact, if the current trends continue, rates of firearm-related violence will soon be at their lowest point since the 1950s [3]. With what is believed better identification and enforcement of the gun laws, there has been a 60% decrease in firearm homicides in New York City alone from 1991 to 1996 [3].

Trauma specialists are confronted every day by clinical problems induced by penetrating traumatic injuries. Our experience in the United States and particularly in South Florida is somewhat different from the rest of the world. Firearms are very frequently the cause of penetrating wounds. Assault-type or hunting firearms are rarely involved in firearm related violence [3]. The semiautomatic pistol has emerged in the 1980s as the firearm of choice for criminal use. Pistols have more or less doubled the ammunition capacity of the revolvers that were used in the past. A major impact of changes in firearm design seems to be an increase in lethality of popular firearms. In one study, nearly 60% of the victims with fatal firearm injuries died where they were shot, before receiving medical care. The mean number of wounds per person injured has also increased [3]. This would explain the large yet declining number of patients suffering from penetrating trauma injuries that we treat at the Ryder Trauma Center in Miami.

This review will focus on penetrating neck injuries, discussing the diagnostic work-up and initial resuscitation and evaluation. We will also present our approach for airway management in patients that suffer these injuries.

Section snippets

Classification

There is no doubt that the diagnosis and treatment of penetrating neck injuries remain controversial. These type of injuries are relatively rare, occurring in 0.4–5% of major penetrating trauma and have been associated with a mortality rate of 0–11% in the civilian population [4]. The majority of penetrating neck injuries in the civilian population are produced by knives or firearms. Ordog [7] suggested a classification based on the mechanism of injury as a predictor of severity, morbidity and

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